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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Both tuberculosis (TB) and HIV infection have been declared global emergencies by the World Health Organization (WHO). The WHO in 1992 estimated that 9-11 million adults and 1 million children, mostly in developing countries, had been infected with HIV. Approximately 4 million of these people were coinfected with both TB and HIV, 3.12 million of whom were in sub-Saharan Africa. Data from sub-Saharan Africa indicate that a serious TB epidemic linked to HIV infection is also currently underway in children. This paper discusses the scope of the problem, diagnosing pediatric TB, the clinical presentation of TB in HIV-infected children, patient compliance and follow-up, anti-TB treatment, adverse reactions to anti-TB treatment, strategies for prevention, and the role of BCG. The incidence of TB is increasing rapidly among both children and adults despite the availability of curative therapy. Prospective studies are needed in order to define the basic clinical, microbiological, and epidemiological features of the resurgence of childhood TB in the context of the HIV epidemic.
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PMID:Childhood tuberculosis and infection with the human immunodeficiency virus. 759 97

The first case of disseminated Mycobacterium bovis infection with meningitis in an AIDS patient is reported. A 54-year-old male HIV-positive patient was admitted for evaluation of fever, weight loss, inappetence, fatigue and malaise. Mycobacterium bovis (non-BCG) was isolated from blood, bone marrow, stool, urine, sputum, abdominal lymph nodes and cerebrospinal fluid. Antituberculous therapy using a five-drug regimen plus steroids resulted in complete recovery.
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PMID:A case of disseminated Mycobacterium bovis infection in an AIDS patient. 761 65

211.032 cases of AIDS were reported from Africa up to December 1992, of which 15-20% were among children. The extent of AIDS cases within the overall population may, however, be 10 times larger, but remains grossly underreported. The most seriously afflicted countries are in East and southern Africa, but HIV-1 infection and associated morbidity are also major problems in the Ivory Coast and Ghana. Of particular concern with regard to the perinatal transmission of HIV and the numbers of orphans is the number of reproductive-age females infected with HIV. Among teenagers and individuals aged 20-24, HIV-infected females outnumber HIV-infected males. A large point-prevalence cross-sectional study conducted among 16 major hospitals in Uganda during 1990 found 16.8% of 2793 under-5 children admitted to be seropositive for antibodies to HIV. 12.8% of the 963 children within the sample aged 18 months to 5 years were HIV-seropositive. The vast majority of HIV-infected children are under 5 years old. Sections consider the prevalence of HIV infection of antenatal clinics, vertical transmission rates, the effect of HIV infection on fetuses, breastfeeding, blood transfusion, clinical aspects, mortality rates, immunization, BCG, measles, and social aspects.
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PMID:HIV infection in African children. 768 19

Tuberculosis is a major global public health problem with 8 million new cases of pulmonary tuberculosis in the world per year and 2.89 million deaths. In India in 1989, the approximate morbidity of tuberculosis was 2%, i.e., there were 15 million cases of pulmonary tuberculosis. Of these 25% were sputum positive, posing a serious threat of transmitting the infection to children. Of the 4 million infectious patients, over 1 million would be considered as chronic or relapsing cases who have been partially treated. The Indian National Tuberculosis Program (NTP) has now completed 25 years. Every year, 1 million new cases of adult tuberculosis are detected. 70% of these patients do not complete standard regimens and 45% do not complete short course regimens. In 1983 about 80.71 million children under 16 years old in India were infected. In a survey carried out in 1990 in urban and rural areas of Delhi, BCG vaccination coverage was 90% in the urban and 84.7% in the rural areas. Impact of BCG vaccination has demonstrated that classical or generalized tuberculosis meningitis, miliary TB, disseminated tuberculosis, and other serious complications of primary infections go on occurring in malnourished BCG-vaccinated children. The variable efficacy of the present BCG vaccine observed in different prospective human trials has shown the necessity of conducting research of immunoregulatory mechanisms, and developing newer vaccines for global control of tuberculosis. Other topics include immune responses to the present BCG vaccine (cellular immunity, macrophage, T-lymphocytes); BCG vaccination and tuberculin test; BCG vaccination by nebulization (aerosol BCG vaccine) by the respiratory route; a booster dose of BCG vaccine in the preschool period; protein energy malnutrition and delayed hypersensitivity reaction; BCG test in non-vaccinated and vaccinated children; HIV infections or their symptoms as a contraindication to BCG vaccination; and BCG lymphadenitis in children (7% in seropositive HIV children).
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PMID:BCG vaccination in India and tuberculosis in children: newer facets. 774 45

This article reviews literature on the epidemiology, pathogenicity, and control of HIV and Mycobacterium tuberculosis coinfection. Regarding pathogenicity, immune system deterioration makes HIV-infected people more likely to develop active tuberculosis on primary or secondary exposure to the bacillus or to suffer reactivation of latent infections, and to experience considerably higher rates of extrapulmonary manifestations, relapses, and death. Regarding epidemiology, as of 1990 there were an estimated 3 million people coinfected with HIV and M. tuberculosis, with some 300,000 active tuberculosis cases and 120,000-150,000 tuberculosis deaths occurring annually among those coinfected. Over 500,000 coinfected people are thought to reside in the Americas, over 400,000 of them in Latin America. In general, the impact of coinfection is evident. Relatively high and increasing prevalences of HIV infection have been detected among tuberculosis patients around the world, and tuberculosis has become a frequent complication of AIDS cases. Moreover, there is no longer any doubt that coinfection obstructs tuberculosis prevention and control. Among other things, it affects BCG vaccination policies, suggests the need to administer preventive chemoprophylaxis to HIV-infected individuals at high risk of harboring or contracting tuberculosis infections, and complicates both detection and treatment of active tuberculosis cases. The recent proliferation of M. tuberculosis strains resistant to multiple drugs, most notably in the United States, compounds the problem. Tuberculosis prevention and control are still technically and economically feasible. However, more must be done to establish surveillance programs with laboratory support. More research is needed to determine what case prevention measures are best-suited to current circumstances and the HIV/AIDS presence. More effective preventive treatment regimens that are well tolerated, well complied with, and do not pose the risk of multiresistance need to be devised. More health workers need to be trained to suspect tuberculosis and to conduct timely and appropriate tests confirming this diagnosis. And finally, more must be done to standardize the types and durations of the various curative treatment regimens employed.
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PMID:Epidemiology of AIDS and tuberculosis. 775 23

After declining for many years, tuberculosis rates have begun to level off in Canada. Groups at particularly high risk include aboriginal Canadians, immigrants from high-prevalence countries, HIV-infected people, and elderly men. If disease is suspected, appropriate investigations, including sputum tests for bacteriology and chest x-ray examinations, should be done. Response to treatment is excellent. Chemoprophylaxis is recommended for certain patients. Vaccination with BCG has a limited but important role, especially for aboriginal Canadians.
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PMID:Tuberculosis in the 1990s. Issues for primary care physicians. 852 Feb 29

Tuberculosis (TB) remains endemic in many parts of the world. In developing countries, TB of the spine remains a major, expensive health problem. Tanzania has therefore since the 1970s reinforced its district and regional TB control efforts. The Ministry of Health has nonetheless reported a recent increase in the incidence of TB in the country. The authors have also noted an increase over the past several years in the number of pediatric patients with TB in the spine. They report retrospectively on 22 consecutive patients aged 3-13 years with TB of the spine who were managed at the Pediatric Surgical Unit of Muhimbili Medical Center in Dar es Salaam, Tanzania, over the period 1988-93. 12 subjects are male and 10 are female. The majority presented with back pain and/or deformity and weakness in the legs associated with difficulty in walking. The diagnosis was based upon radiological as well as hematological findings. Two patients had associated lung lesions and gave AFB-positive sputum. 63.5% were thoracolumbar T11-L2. All patients received chemotherapy, with two also undergoing simple drainage of paravertebral abscesses, and two debridement and bone grafting. There was no formal immobilization except that the children had to sleep on hard beds. All gave a history of BCG vaccination scars. Mantoux or Heaf test was performed on 16 of the 22, 11 of whom were positive. One patient resulted with paraplegia, one with marked paraparesis, and in 17 of 22 the kyphosis/gibbus increased. The authors conclude that laxity in the TB control programs and the widespread extent of HIV could be contributory factors in what appears to be an increase in TB infection in recent years.
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PMID:Tuberculosis of the spine in children at Muhimbili Medical Centre, Dar es Salaam. 778 56

We have been isolated HIV strains from blood specimens of HIV infected individuals in Japan for these 6 years. The number of specimens tested reached approximately 1,700 that ninety percent of them were from hemophiliacs repeatedly injected blood products from the United States. More than 300 of field HIV were successfully isolated from the samples. The isolation rates has decreased to 30 percent in 1993 from 40 percent in 1992, suggesting that treatment with anti-HIV drugs such as AZT and/or ddI may be effective to HIV-infected individuals. Further, both of the viral and genomic sequences of HIV were classified to be clade B virus. The clinical isolates that expressed IHIGPGRAFY sequence at the center of the HIV-V3 domain were found to be neutralized by an anti-clade B-V3 monoclonal antibody, mu 5.5. By individual levels, when asymptomatic seropositives have progressed to disease-states, neutralization core motif of GPGR in approximately 6% of the viruses has changed to GPGG and hydrophilic amino acid changed to hydrophobic amino acid, correlating the loss of binding activity to PND-peptide of Japanese Consensus virus. Further, rapid progressors to HIV-induced diseases showed decreased activity of the binding antibody. By using the Japanese consensus sequence of HIV-1, we successfully constructed chimeric protein secretion vectors by selecting an appropriate insertion site of a carrier protein, and established the PND-peptide secretion system in BCG. The recombinant BCG inoculated guinea pigs were initially screened by delayed-type hypersensitivity (DTH) skin reactions to the PND peptide followed by passive transfer of the DTH by the systemic route.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Induction of protective immune responses by a chimeric soluble protein from a recombinant BCG vector candidate vaccine to HIV-1]. 778 47

Sera of 14 bacteriological confirmed pulmonary tuberculosis and 16 non-tuberculotic or healthy controls were sampled in Ignace Deen University Hospital in Conakry, Quinea. Samples were examined for IgG and IgM antibodies by means of enzyme-linked immunosorbent assay (ELISA) using sonicated M. bovis BCG and M. avium antigens and were tested for antibodies to HIV-1/HIV-2 as well. Median of IgG antibody titres to M. bovis BCG antigen was 1:445 and differed significantly from that of the control group (1:149). The median of IgM antibody titres was 1:79.1 and did not differ statistically from that of control group (1:69.3) as well as the antibody titres against M. avium antigen in the IgG and IgM classes for both analyzed serum groups. Seven of tested TB patients sera were positive for antibodies against HIV-1. The median of IgG antibody titres against M. bovis BCG antigen was 1:442 not differing significantly from values of remaining TB patients as well as the IgM antibody titre (1:109).
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PMID:Detection of serum antibodies in tuberculosis patients. 781 52

The tuberculosis situation in Africa in the AIDS era has become bleak. The tuberculosis incidence has increased in most sub-Saharan African countries, diagnosis has become more difficult, response to treatment, though initially good, is eventually less effective, and patient compliance, which has been a major problem in tuberculosis control before the HIV epidemic, has now become even more difficult. BCG vaccination, already ineffective before the AIDS era in preventing tuberculosis transmission, is now even less an appropriate tool in tuberculosis control. During a four year stay in Agogo Hospital, Ashanti, Ghana, the author has conducted some studies on tuberculosis and Buruli ulcer, which were combined in an academic thesis, and which are briefly summarized in this review. Immunotherapy using a heat-killed strain of Mycobacterium vaccae may bring about a change in future management of tuberculosis and other mycobacterial infections, but further studies are warranted to confirm a promising impression.
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PMID:Tuberculosis in Africa--any news? 785 10


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